Histopathology 15 - Cerebrovascular disease and Trauma

Question 1

What are the 2 main types of cerebral oedema?

Answer 1

Vasogenic (due to disrupted BBB)
Cytotoxic (due to hypoxia/ ischaemia)

Question 2

What is the difference between communicating and non-communicating hydrocephalus?

Answer 2

Communicating = problem with CSF resorption into venous sinuses 
Non-communicating = Due to obstruction in flow

Question 3

What is the normal range for ICP in a supine adult?

Answer 3

7-15mmHg

Question 4

What is the most important contraindication to lumbar puncture?

Answer 4

Pailloedema

Question 5

What is the most common site for non-traumatic intra-parenchymal haemorrhages?

Answer 5

Basal ganglia

Question 6

What is the biggest risk factor for non-traumatic intra-parenchymal haemorrhage?

Answer 6

Hypertension

Question 7

When do congenital arteriovenous malformations tend to become symptomatic?

Answer 7

Between 2nd and 5th decade

Question 8

What is the management of ruptured congenital arteriovenous malformation?

Answer 8

Surgically remove if poss, this may be radiosurgery
Embolise (to stop bleeding)

Question 9

What is a cavernous angioma?

Answer 9

Hemangioma (vascular tumour), which causes a slowing of blood flow through “caverns”

Question 10

When do cavernous angiomas become symptomatic?

Answer 10

When they bleed - which is at low pressure and usually >50 years

so essentially after congenital AVMs

Question 11

What is the most common site of haemorrhage in subarachnoid haemorrhage?

Answer 11

Berry aneurysm rupture
80% at internal carotid artery bifurcation

Question 12

What is the key symptom of subarachnoid haemorrhage?

Answer 12

Sudden onset severe ‘thunderclap’ headache

Question 13

At what size of Berry aneurysm is the risk of rupture greatest?

Answer 13

>6mm

Question 14

How can Berry aneurysms be fixed?

Answer 14

Platinum coiling

Question 15

In which cerebral artery are infarctions most likely?

Answer 15

Middle cerebral artery

Question 16

What % of TBI patients make a good recovery?

Answer 16

31%

Question 17

What are the clinical signs of skull fracture?

Answer 17

Otorrhoea and rhinorrhoea with straw-coloured fluid

Question 18

What is contusion?

Answer 18

Brain collision with skull which causes surface bruising

Question 19

Which structures are mosta affected by traumatic diffuse axonal injury?

Answer 19

Midline structures eg corpus callosum

Question 20

Two types of cerebral infarction

Answer 20

Stroke and TIA

TIA is an important predictor of stroke

Question 21

Commonest vascular territory affected by stroke

Answer 21

Middle cerebral artery

Question 22

Vascular territories affected by TIA

Answer 22

Can be any

characteristically embolic atherogenic debris from the carotid artery travels to the ophthalmic branch of internal carotid

Question 23

Management of stroke

Answer 23

Aspirin +/- dipyridamole

Thrombolytics (if <3h from event)

+/- carotid endarterectomy

Long term: treat HTN, ↓lipids, anticoag

Main imaging: CT-head non-contrast

Question 24

Treatment of TIA

Answer 24

Aspirin + dipyridamole
+/- carotid endarterectomy

Long term: treat HTN, ↓lipids, anticoagulants

**same as stroke except for thrombolytics

Question 25

ACA stroke

Answer 25

contralateral leg paresis, sensory loss, cognitive deficits (e.g. apathy, confusion, and poor judgment) \*\*essentially leg\>arm

Question 26

MCA stroke signs

Answer 26

contralateral weakness and sensory loss of face and arm • cortical sensory loss • may have contralateral homonymous hemianopia or quadrantanopia • if dominant (usually left) hemisphere: aphasia • if non-dominant (usually right) hemisphere: neglect • eye deviation towards the side of the lesion and away from the weak side \*\*doesn't affect legs like ACA

Question 27

PCA stroke signs

Answer 27

contralateral hemianopia or quadrantanopia • midbrain findings: CN III and IV palsy/pupillary changes, hemiparesis • thalamic findings: sensory loss, amnesia, decreased level of consciousness • if bilateral: cortical blindness or prosopagnosia • hemiballismus

Question 28

Basilar artery stroke signs

Answer 28

1. Proximal (usually thrombosis): impaired EOM, vertical nystagmus, reactive miosis, hemi- or quadriplegia, dysarthria, locked-in syndrome, coma 2. Distal (usually embolic, i.e. top of the basilar sydrome): somnolence, memory and behavior abnormalities, oculomotor deficit

Question 29

PICA signs

Answer 29

PICA (lateral medullary or Wallenberg syndrome): ipsilateral ataxia, ipsilateral Horner’s, ipsilateral facial sensory loss, contralateral limb impairment of pain and temperature sensation, nystagmus, vertigo, nausea/vomiting, dysphagia, dysarthria, hiccups

Question 30

Lacunar infarct: where is this?

Answer 30

(deep hemispheric white matter; involving deep penetrating arteries of MCA, circle of Willis, basilar, and vertebral arteries) 1. Pure motor hemiparesis (posterior limb of internal capsule): contralateral arm, leg, and face 2. Pure sensory loss (ventral thalamic): hemisensory loss 3. Ataxic hemiparesis (ventral pons or internal capsule): ipsilateral ataxia and leg paresis 4. Dysarthria-clumsy hand syndrome (ventral pons or genu of internal capsule): dysarthria, facial weakness, dysphagia, mild hand weakness and clumsiness

Question 32

Types of non-traumatic haemorrhage

Answer 32

Intraparnehchymal Subarachnoid

Question 33

Most common cause of intraparenchymal haemorrhage

Answer 33

50% due to HTN

Question 34

Common site of intraparenchymal haemorrhage

Answer 34

Basal ganglia

Question 35

Most common cause of subarachnoid haemorrhage

Answer 35

85% of ruptured berry aneurysms

Question 36

Most common location of SAH

Answer 36

Internal carotid artery bifurcation

Question 37

What causes charcot-bouchard microaneurysms

Answer 37

Non-tramautic intraparnechymal haemorrhage

Question 38

RF of SAH

Answer 38

F\>M, usually \<50yrs, → thunderclap headache, vomiting and LoC, ↑in PKD, Ehler’s Danlos and Pts with Aortic Coarctation. Also associated with vascular abnormalities incl AV malformations, capillary telangiectasias, venous and cavernous angiomas, Ehlers Danlos.

Question 39

Types of traumatic haemorrhage

Answer 39

Extradural Subdural Traumatic parenchymal injury

Question 40

Extradural haemorrhage

Answer 40

Skull fracture, ruptured middle meningeal artery → rapid arterial bleed, lucid interval then LoC,

Question 41

Which type of haemorrhage give syou lucid interval?

Answer 41

Extradural haemorrhage

Question 42

Subdural haemorrhage

Answer 42

Prev history of minor trauma → damaged bridging veins with slow venous bleed, often elderly/alcoholic, associated with brain atrophy, fluctuating consciousness

Question 43

Types of traumatic parenchymal injury

Answer 43

Concussion: Transient LoC and paralysis, recovery in hours or days ● Diffuse axonal injury: Vegetative state, post traumatic dementia ● Contusions: When brain contacts skull +/- fracture. ● Traumatic intracerebral haemorrhage

Question 44

Coup vs contracoup

Answer 44

Coup - where the impact occurs Contracoup - opposite to region impact

Question 45

Causes of increased ICP

Answer 45

: Caused by oedema, space occupying lesion (e.g. tumour, abscess) or both → brain herniation.

Question 46

Six types of brain herniation

Answer 46

Uncal, Central (transtentorial), Cingulate (subfalcine), Transcalvarial, Upward, Tonsillar.

Question 47

Causes ofbacterial meningitis by age

Answer 47

**Neonatal to 3 months**: Group B streptococcus (GBS) early (90% day 1–5) or late (10% 6 days–3 months), E. coli, Listeria monocytogenes. **• 1 month to 6 years:** Neisseria meningitidis (meningococcus), Streptococcus pneumoniae,Haemophilus influenzae type B (Hib). **• \>6 years**: N. meningitidis (14–25 years), Strep. pneumoniae, mumps (pre-MMR). **• Mycobacterium tuberculosis:** Can cause TB meningitis at all ages. Most common in children 6 months–6 years. **• Older adults**: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b (Hib), group B Streptococcus, Listeria monocytogenes

Question 48

Viral causes of meningitis

Answer 48

Enteroviruses (80%), cytomegalovirus (CMV), arbovirus. Herpes simplex virus (HSV) is more likely to cause encephalitis 2. Herpes simplex most common in adults. All others most common in children and infants.

Question 49

meningitis LP finidngs

Answer 49

Question 51

Which lobe of the brain is affected by HSV encephalitis?

Answer 51

Temporal lobe